Primary Neck Cancers ‣ Anatomy

In order to fully understand primary neck cancers, it helps to understand the anatomy and function of the structures in the neck. The neck is a complex anatomic region between the head and the body.

In the front, the neck extends from the bottom part of the mandible (lower jaw bone) to the bones of the upper chest and shoulders (including the sternum and collar bones). The back of the neck is mostly comprised of muscles, as well as the spine. 

The neck is essentially a passageway for air, food, liquids, blood, and more to travel between the head and the rest of the body, through structures such as blood vessels, nerves, and lymph nodes, as well as the larynx, trachea, and esophagus. 

Important Structures in the Neck

Sternocleidomastoid Muscle
This is the large muscle on either side of the neck. This muscle covers and protects many important deeper structures such as the carotid artery and the jugular vein. This muscle starts at the skull just behind the ear (mastoid bone) and travels down to the sternum (breastbone) and clavicles (collarbones).

Thyroid Gland
The thyroid is located at the midline of the neck, under the skin and a few layers of thin muscles. It sits just in front of and to the side of the upper trachea. It secretes thyroid hormone which is important in regulating many functions of the body. The thyroid gland has a right and left lobe which are connected by an isthmus. Learn more about the thyroid.

Parathyroid Glands
These four glands are located just behind the thyroid gland, two on each side. They are critical in helping to regulate levels of calcium in the blood.

Carotid Sheath
This is an envelope of fascia that envelopes three major structures: the carotid artery, internal jugular vein, and vagus nerve.

Additional Major Arteries & Nerves
Just behind the carotid sheath sits the sympathetic nerve plexus, which helps with blood pressure control and other important functions. There are also other major nerves such as the hypoglossal nerve (which controls tongue movement), the spinal accessory nerve (which controls neck and shoulder movement), and the phrenic nerve that innervates the diaphragm (which facilitates breathing).

Larynx
The larynx is often called the voice box because it houses the vocal cords and is responsible for producing sound during speech. It is part of the throat and is located in the middle of the neck.  The framework of the larynx is formed by the cricoid and thyroid cartilage, as well as, other smaller cartilages. Learn more about the larynx.

Esophagus
The esophagus is the passageway for eating. It is located behind the trachea in the lower neck. Food and liquids travel through this muscular tube which travels from the neck through the chest until it connects to the stomach in the abdomen.  

Trachea
The trachea is the passageway for breathing. It begins just below the cricoid cartilage of the larynx and extends into the chest to eventually split into left and right bronchi which continue to divide in the lungs. The trachea is made up of multiple c-shaped cartilage rings and a posterior muscular wall.

Salivary Glands
The submandibular salivary glands and the tail of the parotid salivary gland are located in the upper part of the neck. Learn more about salivary glands.

Lymph Nodes
There are lymph nodes located throughout the body, and several in the neck. Lymph nodes filter fluid in the body and help to fight infections and cancers. Cancers from a site in the head and neck can drain into lymph nodes and lead to the growth of cancer within the lymph node (called a metastatic lymph node). Learn more about lymph nodes.

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Lymphatic Drainage of the Head and Neck

• 1 Lymphatic Vessels
  • 1.1 Superficial Vessels
  • 1.2 Deep Vessels
• 2 Lymph Nodes
  • 2.1 Superficial Lymph Nodes
  • 2.2 Deep Lymph Nodes
  • 2.3 Clinical Relevance: Virchow’s Node
• 3 Waldeyer’s Ring
  • 3.1 Clinical Relevance: Inflamed Palatine Tonsils (Tonsillitis)
• 4 Lymphatics of the Brain

The lymphatic system functions to drain tissue fluid, plasma proteins and other cellular debris back into the blood stream, and is also involved in immune defence. Once this collection of substances enters the lymphatic vessels, it is known as lymph. Lymph is subsequently filtered by lymph nodes and directed into the venous system.

This article will explore the anatomy of lymphatic drainage throughout the head and neck, and how this is relevant clinically. We will also look at Waldeyer’s ring, the collection of lymphatic tissue surrounding the superior pharynx.

Lymphatic Vessels

The lymphatic vessels of the head and neck can be divided into two major groups; superficial vessels and deep vessels.

Superficial Vessels

The superficial vessels drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head.

Deep Vessels

The deep lymphatic vessels of the head and neck arise from the deep cervical lymph nodes. They converge to form the left and right jugular lymphatic trunks:

• Left jugular lymphatic trunk – combines with the thoracic duct at the root of the neck. This empties into the venous system via the left subclavian vein.

• Right jugular lymphatic trunk – forms the right lymphatic duct at the root of the neck. This empties into the venous system via the right subclavian vein.

Lymph Nodes

The lymph nodes of the head and neck can be divided into two groups; a superficial ring of lymph nodes, and a vertical group of deep lymph nodes.

Superficial Lymph Nodes

The superficial lymph nodes of the head and neck receive lymph from the scalp, face and neck. They are arranged in a ring shape; extending from underneath the chin, to the posterior aspect of the head. They ultimately drain into the deep lymph nodes.

• Occipital: There are usually between 1-3 occipital lymph nodes. They are located in the back of the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of the scalp.

• Mastoid: There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the back of the external auditory meatus (the ear canal).

• Pre-auricular: There are usually between 1-3 pre-auricular lymph nodes. They are located anterior to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal region.

• Parotid: The parotid lymph nodes are a small group of nodes located superficially to the parotid gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to the parotid gland that drain the nasal cavities and the nasopharynx.

• Submental: These lymph nodes are located superficially to the mylohoid muscle. They collect lymph from the central lower lip, the floor of the mouth and the apex of the tongue.

• Submandibular: There are usually between 3-6 submandibular nodes. They are located below the mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive lymph from the submental and facial lymph nodes.

• Facial: This group comprises the maxillary/infraorbital, buccinator and supramandibular lymph nodes. They collect lymph from the mucous membranes of the nose and cheek, eyelids and conjunctiva.

• Superficial Cervical: The superficial cervical lymph nodes can be divided into the superficial anterior cervical nodes and the posterior lateral superficial cervical lymph nodes. The anterior nodes lie close to the anterior jugular vein and collect lymph from the superficial surfaces of the anterior neck. The posterior lateral nodes lie close to the external jugular vein and collect lymph from superficial surfaces of the neck.

By TeachMeSeries Ltd (2023)

Fig 1 – The superficial and deep lymph nodes of the head and neck.

Deep Lymph Nodes

The deep (cervical) lymph nodes receive all of the lymph from the head and neck –  either directly or indirectly via the superficial lymph nodes. They are organised into a vertical chain, located within close proximity to the internal jugular vein within the carotid sheath. The efferent vessels from the deep cervical lymph nodes converge to form the jugular lymphatic trunks.

The nodes can be divided into superior and inferior deep cervical lymph nodes. They are numerous in number, but include the prelaryngeal, pretracheal, paratracheal, retropharyngeal, infrahyoid, jugulodigastric (tonsilar), jugulo-omohyoid and supraclavicular nodes.

Clinical Relevance: Virchow’s Node

Virchow’s node is a supraclavicular node, located in the left supraclavicular fossa (located immediately superior to the clavicle). It receives lymph drainage from the abdominal cavity.

The finding of an enlarged Virchow’s node is referred to as Troisier’s sign – and indicates of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels.

Waldeyer’s Ring

Waldeyer’s tonsillar ring refers to the collection of lymphatic tissue surrounding the superior pharynx. This lymphatic tissue responds to pathogens that may be ingested or inhaled. The tonsils that make up the ring are as follows:

• Lingual tonsil – located on the posterior base of the tongue to form the antero-inferior part of the ring.

• Palatine tonsils – located on each side between the palatoglossal and palatopharyngeal arches. These are the common ‘tonsils’ that can be seen within the oral cavity. They form the lateral part of the ring.

• Tubal tonsils – these are located where each Eustachian tube opens into the nasopharynx and form the lateral part of the ring.

• Pharyngeal tonsil –  also called the nasopharyngeal/adenoid tonsil, located in the roof of the nasopharynx, behind the uvulva and forms the postero-superior part of the ring.

Clinical Relevance: Inflamed Palatine Tonsils (Tonsillitis)

The palatine tonsils can become inflamed due to a viral or bacterial infection. In such a case, they appear red and enlarged, and are accompanied by enlarged jugulo-digastric lymph nodes.

Chronic infection of the palatine tonsils can be treated with their removal, a tonsillectomy. When performing a tonsillectomy, there may be bleeding primarily from the external palatine vein and secondarily from the tonsilar branch of the facial artery.

If an infection spreads to the peritonsillar tissue, it can cause abscess formation. This can cause deviation of the uvula, known as quinsy. A quinsy is a medical emergency, as it can potentially cause obstruction of the pharynx. It is treated with draining of the abscess and antibiotics.

By James Heilman, MD [CC-BY-SA-3.0], via Wikimedia Commons

Fig 2 – Quinsy – inflammation of the peritonsillar tissue. Note also how the uvula has deviated to the right as a result of the inflammation.

Lymphatics of the Brain

It was thought that lymphatics were absent from the brain until in 2015, scientists located lymphatic vessels in the brains of mice and subsequently humans. Work is underway to determine and describe the lymphatic vessels involved.

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What to do if the lymph nodes in the neck are inflamed

The enlargement of the lymph nodes in the neck, as a rule, occurs as a result of contact with bacteria and viruses. If the enlargement is caused by an infection, it is called lymphadenitis. Rarely, cancer can be the cause.

The lymphatic system plays a vital role in keeping our body alive and is a major component of our immunity. Lymph nodes can be felt in the neck, chin, armpits and groin. In some cases, no action is required for treatment and a warm compress is enough. Treatment depends on the cause.

Symptoms

The lymphatic system includes a network of organs and lymph nodes located throughout the body. Most of them are in the head and neck area. Swollen lymph nodes indicate that something is wrong in the body. The first signs are sensitivity, soreness and an increase in lymph nodes to the size of a bean and even more.

Depending on the cause of the appearance, the symptoms of the disease may be as follows:

Runny nose, sore throat, fever and other signs of an upper respiratory tract infection.
Swollen lymph nodes throughout the body may indicate HIV, mononucleosis, or immune disorders such as lupus or rheumatoid arthritis.
Swollen limbs may indicate a blockage in the lymphatic system caused by tumors in lymph nodes that are deep under the skin and cannot be felt.

When treatment of lymph nodes in the neck requires a visit to a doctor

Lymph nodes return to normal over time if the cause of the increase was an infection that was treatable. But there are a number of factors in which you should consult a doctor:

• Swelling without apparent cause
• Duration 2-4 weeks
• Knots are difficult to feel and do not move when pressed
• Associated with persistent fevers, night sweats and weight loss
• Accompanied by sore throat and difficulty swallowing.

Why lymph nodes in the neck become inflamed – causes

A lymph node is a small, round or bean-shaped cluster of cells covered with a capsule of connective tissue. The cells are a combination of lymphocytes that produce protein particles that fight viruses and macrophages that break down harmful substances. Lymphocytes and macrophages filter the lymphatic fluid that flows throughout the body and protects us.

Lymph nodes are located in groups, each of which serves a specific area of ​​the body. An increase in a specific area may suggest a cause. The most common is an infection, especially a viral one, such as a cold. But there are other types0035 lymphadenitis of the cervical lymph nodes , such as parasitic or bacterial, which can cause enlargement of the lymph nodes.

Common infections:

• Measles
• Ear infections
• Infection of the tooth – abscess
• Mononucleosis
• Skin infections
• HIV

Atypical infections:

• Tuberculosis
• Sexually transmitted (syphilis and others)
• Toxoplasmosis
• Cat scratch bacterial infection

Autoimmune diseases:

• Lupus
• Rheumatoid arthritis

Cancer:

• Lymphoma
• Leukemia
• Other cancers that have spread to lymph nodes

Complications

If the cause is an infection and not properly treated, complications may occur.

Abscess formation. Localization of the accumulation of pus caused by infection. Pus contains fluid, white blood cells, dead tissue, bacteria, and other harmful elements. If an abscess occurs, drainage or antibiotic treatment may be required. Significant damage can be done if vital organs are affected.

Bloodstream infection. Bacterial, can start anywhere in your body and progress to sepsis caused by significant blood poisoning. Sepsis can lead to multiple organ failure and death. Treatment includes hospitalization and intravenous antibiotics.

Diagnosis

To diagnose an illness, a doctor may need to:

• Medical history
• Medical examination
• Blood test
• Chest x-ray and computed tomography
• Lymph node biopsy (as a last resort).

Treatment of lymph nodes in the neck

If the cause is a virus, the lymph nodes in the neck will recover on their own after the infection itself is treated. But if this does not happen or there is another reason, the following treatment may be required:

• Infection. The most common treatment for swollen lymph nodes is antibiotics. If the cause is HIV infection, treatment appropriate to the disease is required.
• Autoimmune disease. With lupus and rheumatoid arthritis, proper treatment of the disease itself is necessary.
• Cancer. Depending on the type and extent of development, surgery, radiation, or chemotherapy may be required.

Home treatment for lymph nodes in the neck

If your lymph nodes are swollen and painful, you can relieve symptoms in the following ways:

• Exposure to heat. Apply a warm, damp compress, such as a sponge soaked in hot water.
• Painkiller. Aspirin, ibuprofen, and acetaminophen can help relieve pain and bring down a fever. Do not give aspirin to children without the advice of a doctor.
• Rest. A good rest is sometimes all that is needed to bring your condition back to normal.

See also: Lymphatic system

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Lymphadenitis of the face and neck / Lipetsk city dental clinic №1

What are the lymph nodes on the face and where are they located

Lymph nodes on the face act as a kind of lymph filters from toxic substances. This defensive reaction is especially important on the face. Location of lymph nodes:

Behind both auricles on the head On the neck under the ears slightly shifted forward Under the jaw from below Under the beard Under the eyes

Causes of inflammation of the facial lymph nodes

Facial lymph nodes act as “guards” of the body as a whole. And they are sensitive to the invasion of any infection or the beginning of the inflammatory process in the human body.

Inflammation of the lymph nodes on the face can be the result of such troubles as:

Infectious disease (cold, flu, rhinitis, sinusitis, tonsillitis) Tuberculosis Dental problems (periodontal disease, caries) Decreased immunity Skin diseases on the face Allergy Otitis Periodontitis

Inflammation of the lymph nodes on the face often occurs as a result of hypothermia.

Lymphadenitis of the facial node

Inflammation of the lymph nodes on the face signals that there is an infection in the human body and red blood cells “rushed into battle.” And it is worth not only treating the lymph nodes on the face, but conducting a complete diagnosis of the state of health to detect the underlying problem.

The main cause of lymphadenitis of the facial nodes are skin diseases: acne, acne.

Location of lymph nodes

Lymphadenitis of the parotid and behind the ear nodes

Thickening of the lymph nodes on the face near the ears is a companion of inflammatory processes that occur in the ear or salivary gland, or diseases of the throat.

In children, there is a thickening of the parotid and behind the ear nodes on the face with rubella, chickenpox. Such allergic reactions to vaccination are not uncommon. For a more accurate diagnosis, you should consult a surgeon.

Enlarged nodes in the lower part of the face

Lymph nodes in the lower part of the face can become inflamed for various reasons:

Dental problems (inflammation of the gums, caries) Sialoadenitis

With these diseases, there is an intensive removal of erythrocyte breakdown products from the inflammation sites. Lymph nodes in the lower body do not have time to filter the lymph. This causes stagnation in the node and, as a result, its inflammation.

Facial lymphadenitis symptoms

Inflammation of the lymph nodes on the face occurs with prolonged stagnation of lymph in the node itself. Main symptoms:

Thickening of the skin in this area Redness and itching Pain when pressed Increased body temperature

Cases of purulent inflammation of the lymph nodes on the face are not uncommon. With such a complication, pus accumulates in the node itself. The final recovery of the patient occurs after the extraction of purulent accumulations. It can rupture on its own or be removed with minor surgery.

Remember! Inflammatory processes of the lymph nodes on the face are not an entirely innocent disease. It can lead to serious complications:

Meningitis Encephalitis

It is strictly forbidden to self-treat inflammation of the lymph nodes on the face.

Types of lymphadenitis

Lymphadenitis of the facial nodes is:

Acute Chronic um Nonspecific lymphadenitis

The acute form of diseases of the lymph nodes on the face is characterized by the rapid onset of painful symptoms: the course of inflammation Indistinctly expressed localization of the focus “Fading” diseases for a long time Exacerbation when the immune system is weakened

Specific lymphadenitis on the face manifests itself as concomitant manifestations of such diseases as:

AIDS Syphilis Tuberculosis

Nonspecific lymphadenitis manifests itself after various infectious bacteria enter the lymph:

Streptococcus Staphylococcus Various toxins

If pus accumulates in the lymph node on the face, this is purulent lymphadenitis.

Diagnostics

As noted above, lymphadenitis is one of the body’s signals that inflammatory processes are occurring in the human body. And it is worth making a full diagnosis to find the root cause. After all, eliminating the symptoms does not get rid of the main problem.

During the examination, the doctor pays special attention to the location of the inflamed lymph nodes. If they are near the ear, this may indicate otitis media. Purulent inflammation of the node on the face is most often the result of subcutaneous abscesses.

Purulent inflamed lymph nodes on the face in most cases are treated with surgery. But it is not uncommon that the abscess is torn. It is very good if the content comes out. It happens that pus gets inside. Then surgery is simply a must with a more thorough approach. Need general anesthesia and a long process of cleaning the affected area of ​​the face.

Prevention

Avoiding inflammation in the lymph node is quite easy:

Follow the strengthening of the immune system. This will help to avoid colds, viral diseases. Elementary hygiene of the oral cavity and ears will save you from stagnation of lymph in these areas of the face.